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Midterm safety and outcome of balloon angioplasty of native aortic coarctation in neonates and young infants and initial experience of prepartial dilatation using high-pressure noncompliant balloon


1 Departments of Pediatrics and Cardiology, Army Hospital Research and Referral, New Delhi, India
2 Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
3 Department of Cardiac Anesthesia, Command Hospital (Air Force), Bengaluru, Karnataka, India
4 Department of Cardiac Anesthesia, Command Hospital, Udhampur, Jammu and Kashmir, India
5 Department of Cardiothoracic and Vascular Surgery, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India

Correspondence Address:
Dr. Harmeet Singh Arora
Departments of Pediatrics and Cardiology, Army Hospital Research and Referral, New Delhi - 110 010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_197_21

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Year : 2022  |  Volume : 15  |  Issue : 2  |  Page : 121-127

 

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Background: Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications. Aim: This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon. Materials and Methods: Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all. Results: A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34–80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A (P < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients (P < 0.001), in those with borderline/mildly hypoplastic arch (P = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg (P = 0.02). Median time to re-coarctation was significantly delayed in Group B (P < 0.001). There were no major complications or mortality in either group. Conclusions: BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.






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1 Departments of Pediatrics and Cardiology, Army Hospital Research and Referral, New Delhi, India
2 Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
3 Department of Cardiac Anesthesia, Command Hospital (Air Force), Bengaluru, Karnataka, India
4 Department of Cardiac Anesthesia, Command Hospital, Udhampur, Jammu and Kashmir, India
5 Department of Cardiothoracic and Vascular Surgery, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India

Correspondence Address:
Dr. Harmeet Singh Arora
Departments of Pediatrics and Cardiology, Army Hospital Research and Referral, New Delhi - 110 010
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_197_21

Rights and Permissions

Background: Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications. Aim: This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon. Materials and Methods: Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all. Results: A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34–80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A (P < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients (P < 0.001), in those with borderline/mildly hypoplastic arch (P = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg (P = 0.02). Median time to re-coarctation was significantly delayed in Group B (P < 0.001). There were no major complications or mortality in either group. Conclusions: BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.






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